Bacaan Penuh ( bersaiz 15.7 MB)

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31

Hospital Director Emergency Physician Supervisor Assistant Medical Officer Sister Medical Officer in Charge

Medical Officer

Sr. Assistant Medical Officer

Staff Nurse Assistant Medical

Officer

Assistant Nurse Medical Attendant Ambulance Driver

Head of Emergency and Trauma Department (Emergency Physician)

Secretary

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32

Ambulance Service

Emergency and Trauma

Department

Medical Emergency Coordinating Centre Pre Hospital Care

Emergency and Clinical Care

Triaging Services

Care of the critically ill

Care of the Semi-critically ill

Care of the Non-critically ill

Observation medicine

One Stop crisis Centre

Subspecialty Services

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34

Hospital Level

2010

2015

2020

IV (300pt/day) 14 20 28

III (200pt/day) 9 14 18

II (150pt/day) 3 3 3

(52)

-35

IV

300 cases/day

Hospital Level Zone No. of case/day No. of

case/shift

Total

Red (10 %) 30 10

No. of Medical Officer

2

No. of MO needed x 5 (taking into consideration MOs that are on leave/nights off)

Yellow (40%) 120 40 4

Green (50%) 150 50 2

8 x 5 40

III 200 cases/day

Total

Red (10%) 20 7 1

Yellow (40%) 80 27 3

Green (50%) 100 35 2

6 x 5 30

II 150 cases/day

Total

Red (10%) 15 5 1

Yellow (40%) 60 20 2

Green (50%) 75 25 1

4 x 5 20

I Total

5

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39

Triage

Color Code Category Sub-Category

Usual Presentation

Cardiac arrest.

Stridor/respiratory arrest/RR>30 or <10

Severe respiratory distress/agonal or gasping type respiration. SpO <90.

Unresponsive trauma patient.

Severe bradycardia (HR<60) or tachycardia (HR>150) with signs of hypo-perfusion.

Hypotension (SBP<90) with signs of hypo-perfusion.

Trauma patient who requires immediate fluid resuscitations.

Chest pain (Anginal type), pale, diaphoretic.

Anaphylactic reaction.

Baby that is flaccid (unresponsive)

Unresponsive with history of poisoning.

Hypoglycemia with a change in mental status.

Exsanguinations hemorrhage

Severe crush injuries to limbs

Extensive burns (> than 25% BSA) or involve facial region

Near-drowning Firearms wounds to head, neck, trunk or abdomen or trajectory undetermined

Elevated BP systolic >220 mmHg or diastolic >120 mmHg with systemic symptoms or neurological deficit

(57)

40

Triage

Usual Presentation

Altered conscious level but not comatose Head injured: GCS>13

GCS full but pupils unequal

Fractures of long bones of lower limbs/pelvis

Active chest pain, suspicious for coronary syndrome, but does not require an immediate life-saving intervention, stable.

Chest pain – visceral and not associated with other symptoms Immunocompromised (on chemotherapy, SLE) with a fever.

A suicidal or homicidal patient

Open fractures of upper limbs

Spine injuries

Eye injuries with loss or impaired vision

Dislocations of major joints

Limb amputation: total or near-total

Burns 15-25% of BSA regardless of depth and/or 10-20% 3rd degree burns with no compromise to airway and circulation

Vascular injuries

Uncontrollable major bleeding

Patients with acute abdomen

Chemical exposure involving eyes

Poisoning or drug overdose with impairment of conscious level Severe pain: Pain score: 7 - 10/10

Post-ictal states with neurological deficit

Mild or moderate dyspnoea with saturation >95% and/or rate <40 min

Hyperventilation and unable to maintain posture

Arrhythmias: heart rate <150 or >60/min

Elevated BP systolic <220 mmHg or diastolic <120 mmHg with minimal systemic symptoms but no neurological deficit

Other medical urgencies requiring intravenous intervention and intermittent monitoring only:

Dehydration Diarrhea with vomiting Adult pyrexia > 40º

Child aged 1-3 months with T>38º Signs of infection

Dialysis problems Acute psychotic episode

Chemotherapy or immunocompromise <3 months-HR>180, RR>50 3 months-3 years-HR>160, RR>40 3-8 years-HR>140,RR>30 >8 years-HR>100, RR>20 SPO <92ESI

High Risk Situation

or Confused/lethargy /disorientated or Severe pain/Distress or

Unable to walk but airway is secure, haemodynamically stable and on trolleys High Risk Seen

within 30 minutes Yellow

c

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41

Triage

Usual Presentation

Children less than 2 years Senior citizens more than 65 years

Chest pain – No risk factors and not associated with other symptoms, normal ECG

Abdominal pain Abuse/Neglect/Assault

Elevated blood sugar without any major symptoms Mild asthma

Acute urinary retention

Closed fracture of upper limbs or ankle with major angulations Dislocations of small joints

Diarrhea and/or vomiting with dehydration

G1

Requires many resources Non-critical

Green

Non-aggressive psychiatric patients Foreign body

Minor allergic reaction

Burns <15% of BSA regardless of depth and/or <10% 3rd degree burns

Minor trauma

Diarrhea and/or vomiting with no dehydration Lumps and bumps

Abdominal pain: chronic

General medical conditions or minor illnesses not requiring monitoring Ear ache

Nail prick

Acute infective eye conditions Fever >38º for adult age

Fever in children between 2 to 12 years of age

G2

Requires minimal resources

Sore throat – no respiratory symptoms Simple skin diseases – chronic

Simple upper respiratory tract infection in adults Chronic trauma injuries >6 months

Missed appointments Medications exhausted Second opinion seeking

Wound dressing and opening stitches (STO) Medical Certificate

Specialist clinic cases

Routine change of urinary catheter and naso-gastric tube

G3

Non-emergency

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54

No. Prescriber

categories

Notes Generic Name

1. Acetylsalicylic Acid 300mg Tablet C

2. Albendazole 200mg Tablet C

3. Allopurinol 300mg Tablet A/KK

4. Amoxicillin 250mg capsule B

5. Amoxicillin 500mg + Clavulanate 125mg Tablet A/KK

6. ARB Oral A

7. Ascorbic Acid 50mg Tablet C

8. Atenolol 100mg Tablet B

9. B Complex Tablet C

10. Bacampicillin 400mg Tablet B

11. Benzhexol 2mg Tablet B

12. Bisacodyl 5mg Tablet C

13. Bromhexine 8mg Tablet B

14. Calcium Lactate 300mg Tablet C

15. Cefuroxime 250mg Tablet A/KK

16. Celecoxib 200mg Capsule A*

17. Cephalexin 250mg Capsule B

For hospital with Emergency Physician only

18. Charcoal Activated 250mg Tablet C

19. Chlorpheniramine 4mg Tablet C

20. Chlorpromazine 100mg Tablet B

21. Cinnarizine 25mg Tablet B

(72)

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No. Prescriber

categories

Notes Generic Name

23. Cloxacillin Sodium 250mg Capsule B

24. Dexchlorpheniramine 2mg, 6mg Tablet B

25. Diclofenac Sodium 50mg Tablet B

26. Digoxin 0.25mg Tablet B

27. Diosmin 450mg & Hesperidin 50mg Tablet A/KK

28. Diphenoxylate HCl 2.5mg + Atropine Sulphate 25mcg Tablet B

29. Doxycycline 100mg Capsule B

30. Erythromycin EthylSuccinate 400mg Tablet B

31. Etoricoxib 120mg Tablet A*

32. Ferrous Fumarate 200mg Tablet C

33. Fluvoxamine 50mg Tablet B

34. Folic Acid 5mg Tablet C

35. Frusemide 40mg Tablet B

36. Glibenclamide 5mg Tablet B

37. Gliclazide 80mg Tablet B

38. Glyceryl Trinitrate 0.5mg Tablet C

39. Griseofulvin 125mg Tablet B

40. Haloperidol 1.5mg Tablet B

41. Haloperidol 5mg Tablet B

42. Hydrochlorothiazide 25mg Tablet B

43. Hyoscine N-Butyl bromide 10mg Tablet B

44. Ibuprofen 200mg Tablet B

45. Indomethacin 25mg Capsule B

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51. Mefenamic Acid 250mg Capsule B

52. Metformin 500mg Tablet B

53. Methyldopa 250mg Tablet B

54. Metoclopramide 10mg Tablet B

55. Metoprolol 100mg Tablet B

56. Metronidazole 200mg Tablet B

57. Nifedipine 10mg Tablet B

58. Omeprazole 40mg Tablet B

59. Oral Rehydration Salt C

60. Paracetamol 500mg Tablet C

61. Penicilline 125mg Tablet C

62. Potassium Chloride 600mg Tablet B

63. Perindopril 4mg Tablet B

64. Prazosin 1mg Tablett B

65. Prednisolone 5mg Tablet B

66. Prochlorperazine 5mg Tablet B

67. Prolase Tablet B

68. Propranolol 40mg Tablet B

69. Ranitidine 150mg Tablet B

70. Salbutamol 2mg Tablet B

48. Levonorgestrel 150mcg & Ethinyloestradiol 30mcg Tablet C

49. L-Thyroxine 0.1mg Tablet B

50. Magnesium Trisilicate Tablet C

No. Prescriber

categories

Notes Generic Name

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72. Isosorbide Dinitrate 10mg Tablet B

73. Tetracycline 250mg Capsule B

74. Theophylline 125mg Tablet B

75. Theophylline 250mg SR Tablet B

76. Tramadol 50mg Capsule A/KK

77. Tranexamic Acid 250mg Capsule B

78. Triprolidine HCl 2.5mg & Pseudoephedrine HCl 60mg Tablet B

79. Vitamin B1, B6, B12 Tablet B

71. Sulphamethoxazole 400mg & Trimethoprim 80mg Tablet B

No. Prescriber

categories

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58

No. Prescriber

categories

Notes Generic Name

1. Albendazole 200 mg/5 ml Suspension B

2. Ammonium Bicarbonate, Tincture Ipecac, etc Mixture B

3. Ampicillin 125mg/5ml Suspension B

4. Bromhexine 4mg/5ml Elixir B

5. Carminative Mixture C

6. Cephalexin 125mg/5ml Syrup B

7. Cloxacillin 125mg/5ml Suspension B

8. Dexchlorpheniramine Maleate 2mg/5ml Syrup B

9. Diphenhydramine HCl 10mg/5ml Elixir (Pediatric) C

10. B

11. Erythromycin 200mg/5ml Suspension B

12. Lactulose 3.35g/5ml Liquid B

Strength available: 1mg/5ml

Diphenhydramine HCl 14mg/5ml & Ammonium Chloride 135mg/5ml Expectorant (Adult)

17. Paracetamol 120mg/5ml Syrup C

18. Phenoxymethyl Penicillin 125mg/5ml Syrup C

19. Prednisolone 3 mg/5 ml Syrup B

20. Potassium Citrate Mixture C

21. Promethazine HCl 5 mg/5 ml Syrup B

22. Salbutamol 2mg/5ml Syrup B

23. B

24. B

13. Liquid Paraffin C

14. Magnesium Trisilicate Mixture C

15. Multivitamin Syrup C

16. Nystatin 100,000 units/ml Suspension B

Sulphamethoxazole 200 mg

& Trimethoprim 40 mg/5ml Suspension

Triprolidine HCl 1.25mg

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No. Prescriber

categories

Notes Generic Name

1. Aqueous Cream C

2. Benzyl Benzoate 25% Emulsion C

3. Betamethasone 17-Valerate 1:10 Cream B

4. Calamine Cream C

5. Glycerine C

6. Hydrocortisone 1% Cream B

7. Lignocaine 2% Jelly B

8. Magnesium Sulphate 45% Paste C

9. Methyl Salicylate 25% Ointment C

10. Miconazole 2% Cream B

11. Neomycin 0.5% Cream B

12. Nystatin 100,000 units/g Cream B

13. Silver Sulphadiazine 1% Cream B

14. Vaseline Ointment C

(77)

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No. Prescriber

categories

Notes Generic Name

1. Acriflavine 0.1% Lotion C

2. Calamine Lotion C

3. Cetrimide 2% Lotion C

4. Chlorhexidine Gluconate 4% Solution C

5. Chlorhexidine Mouthwash 0.2% C

6. Chlorinated Lime Solution & Buffered Acetate Solution C

7. Menthol 1.6% in Industrial Methylated Spirit Inhalation C

8. Potassium Permanganate 1.5% Solution C

9. Thymol Gargle C

No. Prescriber

categories

Notes Generic Name

1. Chloramphenicol 0.5% Eye Drops C

2. Chloramphenicol 5% Ear Drops C

3. Chloramphenicol Eye Ointment C

4. Ephedrine 0.5% Nasal Drop A/KK

5. Sodium Bicarbonate 5% Eardrop C

(78)

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No. Prescriber

categories

Notes Generic Name

1. C

2. Bisacodyl 5mg, 10mg Suppository C

3. Clotrimazole 200mg, 500mg Pessary B

4. Diclofenac 12.5mg Suppository A*

5. C

6. A/KK

7. MDI Inflammide or equivalent B

8. MDI Combivent or equivalent B

9. Paracetamol 125mg Suppository B

10. Paracetamol 250mg Suppository B

Anusol Suppository

(Bismuth Subgallate & Benzyl Benzoate Suppository)

Glycerin 25 % & Sodium Chloride 15 % Disposable Enema [Ravin]

Lignocaine, Aluminium Acetate, Zinc Oxide & Hydrocortisone Ointment

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No. Prescriber

categories

Notes Generic Name

1. Acetylcysteine 2g/10ml Inj (Parvolex®) A*

2. Adenosine 6mg/2ml Inj (Adenocor®) B

3. Adrenaline 1mg/ml Inj B

4. Albumin Human 20%/25% Inj B

5. Amiodarone 150mg/3ml Inj A*

6. Anti Rabies Vaccine Inj (Verorab®) B

7. Anti Tetanus Toxoid Inj ( ATT vaccine) C

8. Antivenom Cobra/King Cobra/Inj B

9. Antivenom Snake Serum (Polyvalent®) B

10. Antivenom Malayan Pit Viper Inj B

11. Antivenom Sea Snake Inj B

12. Atropine Sulphate 1mg/ml Inj B

13. Bupivacaine 0.5% Vial A

14. B2 Agonist B

15. Calcium Gluconate 1g/10ml Inj B

16. Calcium Polystyrene Sulphonate Powder (Kalimate®) A

17. Ceftriaxone Inj A

18. Cefoperazone Inj 1g A

19. Cefuroxime Inj 750mg A

20. Deferrioxamine B Methanesulphonate 0.5g Inj (Desferal®) A

21. Desmopressin Acetate 4ug/ml (Minirin®) A

22. Dexamethasone 8mg/2ml Inj B

23. Dextrose 50%w/v Inj (10ml) B

24. Diazepam/Midazolam B

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No. Prescriber

categories

Notes Generic Name

27. D-Penicillamine 0.25 g Capsule A

28. A*

30. Flumazenil 0.5mg/5ml Inj (Anexate®) B

31. Frusemide B

32. Fuller’s Earth Powder C

33. Glucagon 1mg/ml Inj B

34. Glyceryl Trinitrate 50mg/10ml Inj A

35. Hep B Im.globulin, Human 0.5ml Inj (Hyperhep/Hepabig®) A

36. Human Tetanus Im.globulin 250u/vial (Hypertet/Serotet®) B

37. Hydrocortisone 100mg Inj C

39. Isoket 2mg Amp A

38. Inj NSAIDs C

40. Ipratropium bromide Neb Solution (Atrovent®) B

41. Isoprenaline 1mg/5ml Inj (Isuprel®) B

42. Ketamine 10mg Vial A

43. Labetolol 25mg Amp B

44. Lignocaine 100mg/5ml Inj Lorazepam Inj B

45. Magnesium Sulphate (MgSO4) B

47. Methyl-Prednisolone 500mg Vial B

46. Methylase Inject A

48. Metronidazole Inj B

25. Dobutamine 250mg/20ml Inj A

26. Dopamine 200mg/5ml Inj B

Enoxaparin 60mg Injection or Fondaparinoux 2.5 mg Injection

(81)

64

No. Prescriber

categories

Notes Generic Name

53. Opiods B

54. Pralidoxime Mesylate 500mg/20ml Inj (Pampara) B

55. Propofol 200mg Amp A

68. Water for Injections (10ml) C

57. Protamine Sulphate 50mg/5ml Inj (Prosulf®) B

56. Panto Prazole Inj B

58. Phenytoin Sodium Inj B

59. Ranitidine 50mg Amp B

60. Salbutamol Resp Solution 0.5% B

61. Sodium Bicarbonate 8.4%w/v Inj (10ml) B

62. Sodium Thiosulphate 500 mg/ml Injection B

63. Streptokinase Inj 5 MU Vial B

64. Terbutaline Resp Solution 10mg/ml B

65. Vasopressin 20 units/ml Injection (Pitressin®) B

66. Verapamil 5mg/2ml (Isoptin®) A/KK

67. Vitamin K1 10 mg/ml Injection B

52. Noradrenaline 4mg/4ml A _{Emergency Physician only}For hospital with

51. Neostigmine Methylsulphate 2.5mg/ml Inj B

50. Naloxone HCl 0.02mg/ml Inj (neonate) B

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Bil. Subject Structure

V A B

M D O U M D O U M D O U M D O U

1. Wheelchairs X X X X

2. Transport Trolleys X X X X

3.

Triage Trauma Immobilization Set

– Shown Below

X X X X

4. Oxygen Tank &

Oxygen Regulator X X X X

5. Bag-valve Mask,

HFM & Tubing X X X X

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Bil. Subject Structure

V A B

1. Upper Limb

Immobilizers X X X X

2. Lower Limb

3. Cervical Collar

(Various Sizes) X X X X

4. Arm slings X X X X

Bil. Subject

No: Bay Structure

V A B

1.

Non Invasive BP with SpO₂ Parameters

1:1 X X X X

2. Thermometers

(Tympanic/Digital) 1:1 X X X X

3. ECG Machine 1:1 X X X X

4. Pulse Oxymetry 1:1 X X X X

5. Dextrostix Set 1:1 X X X X

6. Dressing Sets 1:1 X X X X

7. Examination Couch 1:1 X X X X

8. Table and Chair 1:1 X X X X

9. Medication Fridge 1:1 X X X X

2. Secondary Triage/Rapid Initial Assessment

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V A B

1.

Table & Chairs Ergonomically Design

X X X X

2. Stationery X X X X

3. Record & Receipt

Books X X X X

4. Electronic Call

Numbering System X X X X

5. PA System X X X X

6. Cabinet X X X X

7. Computer (Desktop) X X X X

8. Telephones X X X X

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Bil. Subject Structure

V A B

1. Cushion Seats X X X X

2. Color Television

– Plasma Screen X X X X

3. Electronic call

number system X X X X

4. Notice Boards X X X X

5. Information Center X X X X

6.

Patient Education material – Video, Reading Material etc

X X X X

7.

Air Conditioning System and Air Change Management

X X X X

8. Closed Circuit TV

System and Security X X X X

9. Children Playing

Area X X X X

10. Pipeline Music X X X X

11. Breast Feeding

Room/Area X X X X

12. Complaints

Management Box X X X X

13. Prayer Area/Room X X X X

14. Toilets X X X X

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Bil. Subject Structure

V A B

1. Diagnostic Set

– Wall Mounted X X X X

2. Sphygmomanometer X X X X

3. Examination Couch X X X X

4. Weighing Machine X X X X

5. Doctor’s

Stethoscope X X X X

6. Ergonomic Doctor’s

Examination Table X X X X

7.

Comfortable (Ergonomically Design) Chairs

X X X X

8. Illuminated X-ray

Viewer X X X X

9. Phone Lines X X X X

10. Notice Board X X X X

11. Electronic Call

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V A B

1. Diagnostic Set

– Wall Mounted X X X X

2. Sphygmomanometer X X X X

3. Examination Couch X X X X

4. Phone Lines X X X X

5. Resuscitation Trolley X X X X

6. Ergonomic Doctor’s

Examination Table X X X X

7.

Comfortable (Ergonomically Design) Chairs

X X X X

8. Illuminated X-ray

Viewer X X X X

9. Padded Wall or

Equivalent X X X X

10. Notice Board X X X X

11. Electronic Call

Numbering System X X X X

12. CCTV X X X X

13. Panic button

/Alert System X X X X

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V A B

1. Foreign Body

Removal Set 1 X X X X

2. Dextrostix Set 2 X X X X

3. Pulse Oxymetry 1 X X X X

4.

Airway Management Set

– BVM, HFM, Nasal Prongs, Oro- & Nasopharyngeal Airways, ETTs, Laryngoscopes, Stylet

1 X X X X

5.

Emergency Cart – Consumables (Drugs, Cannulas, Syringes, Needles, IVD tubing, IV Solutions etc)

1 X X X X

6. Manual Defi brillator 1 X X X X

7. Oxygen Tank with

Regulator 1 X X X X

8. Vital Sign Machine

– ECG, BP, HR 1 X X X X

9. Paediatric Weighing

Machine 1 X X X X

10. Neonate Weighing

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Bil. Subject

No:Bay Structure

V A B

1.

Physiological Monitor

– Cardiac/ECG, BP, SpO₂ Monitoring

1:1 X X X X

2.

Wall Source Oxygen & Regulator with Mark 4: 2 per bay with Bubble Humidifi er each

2:1 X X X X

3.

Wall Suction Regulator & Suction Pump

1:1 X X X X

4. Emergency Critical

Trolley 1:1 X X X X

5. Stethoscope 1:1 X X X X

6. Procedure

/Examination Light 1:1 X X X X

7. Oxygen Tubing,

HFM/Nasal Prongs 1:1 X X X X

8.

Foldable Plastic Examination Screen or Equivalent

1:1 X X X X

9.

Light Examination Ceiling Mounted /Wall Mounted

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Bil. Subject

V A B

1. Portable Ventilator

with PEEP 1:4 X X X X

2. Defi brillator 1:2 X X X X

3.

– BVM, Oro- & Nasopharyngeal Airways, ETTs, Laryngoscopes, Stylet etc

1:2 X X X X

4.

Emergency Resuscitation Cart/ Trolley or Equivalent – Consumables (Drugs, Cannulas, Syringes, Needles, IVD Tubing, IV Solutions etc)

(91)

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Bil. Subject

No:Katil Structure

V A B

1.

Point of Care Testing (Laboratory)

– shown below

1 Set X X X X

2. Infusion Pumps 1:4 X X X X

3. Syringe Pumps 1:4 X X X X

4. Blood Warmer 1:4 X X X X

5. Blood Cuff with

Manometer 1:4 X X X X

6. Illuminated X–ray

Viewer 1:4 X X X X

7. ETCO₂ Monitor 1:8 X X X X

8. Portable Ultrasound

Machine 1 Unit X X X X

10. CBS Testing 1:8 X X X X

12.

Trauma

Immobilization Set

– shown below

1:4 X X X X

13. Diagnostic Set 1:4 X X X X

14. Entonox with

Delivery Device 1:4 X X X X

15. Air-conditioning All Area X X X X

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No:Katil Structure

V A B

17. Color Coding All Cubicles X X X X

18.

Foldable Rigid Partitions or Equivalent

All Cubicles X X X X

19. Patient transport kit

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V A B

1. Arterial Blood

Gaseous Machine X X X X

2.

BUSE with Lactate and Haematocrite Machine

X X X X

3. FBC machine X X X X

4. UFEME Machine X X X X

5.

Cardiac Enzymes (Troponins/CKMB/ FABP) with Cardiac Enzymes Reader

X X X X

6. Coagulation Profi le X X X X

7. D-Dimmer X X X X

8. BNP X X X X

9. PT/APTT X X X X

10. Urine For Pregnancy

Test X X X X

11. Urine for Drug

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V A B

1. Transport Trolley X X X X

2. Long Spinal Board X X X X

3. Short Spinal Board X X X X

4. Scoop Stretcher X X X X

5. Pole Stretcher X X X X

6. Basket Stretcher X X X X

7. Extrication Device X X X X

8. Automated External

Defi brillator X X X X

9. Portable

Resuscitator X X X X

10. Portable Transport

Ventilator (+PEEP) X X X X

11. Portable Cardiac

Monitor X X X X

12. Portable Suction

Pump X X X X

13. Two Way

Communication Set X X X X

14. Portable Handheld

SpO₂ monitor X X X X

15. Oxygen Cylinder at

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Bil. Subject Structure

V A B

1. Upper Limb

2. Lower Limb

3. Traction Splints X X X X

4. Cervical Collar

5. Pelvic clamp

/Immobilizer X X X X

(96)

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V A B

1. Color Coding All Area X X X X

2. Air-conditioning All Area X X X X

3. Alert/Alarm system All Area X X X X

4. X-ray – Portable or Equivalent Facility on Site

1 Set X X X X

5.

Image Intensifi er* (To be Located on OT/Angiogram Suite)

1:1 X X X X

6.

Foldable Rigid Partition or Equivalent

All Cubicles X X X X

7. Portable Ultrasound

/Echocardiography 1 Unit X X X X

8.

Point of Care Testing (Stat Lab)

– as above

1 Set X X X X

9. Fluid warming

cabinet 1 X X X X

10. Medication Fridge 1 X X X X

11. Blood Fridge 1 X X X X

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V A B

1.

Trauma Resuscitation Bay

– shown below

X X X X

2.

Medical Resuscitation Bay

– shown below

X X X X

3.

Pediatric Resuscitation Bay

– shown below

X X X X

4.

Isolation/ Decontamination Resuscitation Bay

– shown below

Identifi ed Emergency Dept ONLY

(98)

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Structure No: Bay

V A B

1.

Medical Pendant with 2 Arm (Power, Gases, I/V, Monitoring, Equipment)

O₂ – 2 Source for Each Arm

Vacuum – 1 Source for Each Arm

Medical gases – 1 Source for Each Arm

1:1 X X X X

2.

Physiological Monitor – ECG, BP, HR, RR, SpO₂, ETCO₂ and IABP (Optional)

1:1 X X X X

3.

ICU Type Ventilator with Non-invasive Ventilation (NIV)

1:1 X X X X

4. Manual Defi brillator 1:1 X X X X

5.

Wall Suction Regulator & Suction Pump for each Source

2:1 X X X X

6.

Oxygen Source & Regulator with Mark 4 (>/= 2) and with Bubble Humidifi er

4:1 X X X X

7.

Emergency Critical Trolley with X-ray Casing (Resuscitation Bed)

1:1 X X X X

8.

Airway Management set – BVM, HFM, Nasal Prongs, Oro- & Nasopharyngeal Airways, ETTs, Laryngoscopes, Stylet

(99)

82

Bil. Subject

Structure No: Bay

V A B

10.

Procedure Light /Examination Light - Ceiling Mounted

1:1 X X X X

11.

Trauma

Immobilization Set

– shown below

1:1 X X X X

12.

Emergency Trolley – Consumables (Drugs, Cannulas, Syringes, Needles, IVD Tubing, IV Solutions etc)

1:1 X X X X

13. Entonox with

Delivery Device 1:2 X X X X

14. Ceiling-mounted

X-ray 1:1 X X X X

16. Volumetric

/Infusion Pump 1:1 X X X X

17. Rapid Fluid Infusion

Device 1:8 X X X X

18. Diagnostic Set 1:1 X X X X

19. Adult Interosseous

Device 2:1 X X X X

20.

Surgical Set for Pelvic External Fixator Including Battery Operated Drill

(100)

83

Bil. Subject Structure

V A B

1. Upper Limb

2. Lower Limb

3. Traction Splints X X X X

4. Cervical Collar

5. Pelvic Clamp

/Immobilizer X X X X

(101)

84

No: Bay Structure

V A B

1.

1:1 X X X X

2.

Physiological Monitor - ETCO₂, ECG, RR, BP, HR, SpO₂

1:1 X X X X

3. Portable ventilator

with inbuilt CPAP/PEEP 1:1 X X X X

4. Manual Defi brillator

+ TCP 1:1 X X X X

5. Wall Suction Regulator

& Suction Pump 1:1 X X X X

6.

Oxygen Source & regulator with Mark 4 (>/=2)

1:1 X X X X

7.

1:1 X X X X

8.

1:1 X X X X

10. Procedure

/Examination Light 1:1 X X X X

11. Wall-mounted X-ray 1:1 X X X X

12.

(102)

85

Bil. Subject Structure

V A B

1.

Medical Pendant with 2 Arm(Power, Gases, I/V, Monitoring, Equipment)

1:1 X X X X

2.

Pediatric Monitor – Cardiac/ECG, BP, HR, SpO₂ ETCO₂

1:1 X X X X

3. Pediatric ICU Ventilator 1:1 X X X X

4.

Manual Defi brillator with Pediatrics Paddles/Pads

1:1 X X X X

6.

Oxygen Source & Regulator with Mark 4 (>/=2)

1:1 X X X X

7. Pediatric Resuscitation _{Bed/Bay & Warmer} 1:1 X X X X

8.

Pediatric Airway Management Set – BVM, HFM, nasal Prongs, Oro- & Nasopharyngeal Airways, ETTs, Laryngoscopes, Stylet

1:1 X X X X

9. Pediatrics _Stethoscope 1:1 X X X X

10. Procedure Light 1:1 X X X X

11.

Emergency Trolley – Consumables (Drugs, Cannulas, Syringes, Needles, IVD Tubing, IV Solutions etc, Interosseous Needle

1:1 X X X X

(103)

86

Bil. Subject Structure

V A B

1.

1:1 X X X X

2.

Pediatric Monitor – Cardiac/ECG, BP, HR, SpO₂ ETCO₂

1:1 X X X X

3. Neonate Ventilator 1:1 X X X X

4.

Manual Defi brillator with Pediatrics Paddles/Pads

1:1 X X X X

6.

Oxygen Source & regulator with Mark 4 (>/=2)

1:1 X X X X

7.

Neonate Resuscitation (Open Care) Bed /Bay & Warmer

1:1 X X X X

8.

Pediatric/Neonate Airway Management Set

1:1 X X X X

9. Pediatrics

Stethoscope 1:1 X X X X

(104)

87

Bil. Subject Structure

V A B

11. Portable Incubator 1 Set X X X X

12.

Emergency Trolley – Consumables (Drugs, Cannulas, Syringes, Needles, IVD Tubing, IV Solutions etc, Interosseous Needle

1:1 X X X X

13. Umbilical Vein

(105)

88

V A B

1.

1:1 X X X X

2.

Monitor

– Cardiac/ECG, BP, HR, SpO₂

1:1 X X X X

3.

Portable Ventilator with Inbuilt CPAP/PEEP

1:1 X X X X

4. Manual Defi brillator 1:1 X X X X

6.

Oxygen Source & Regulator with Mark 4 (>/=2)

1:1 X X X X

7.

1:1 X X X X

8.

Airway Management Set – BVM, HFM, nasal Prongs, Oro- & Nasopharyngeal Airways, ETTs, Laryngoscopes, Stylet

1:1 X X X X

(106)

89

Bil. Subject Structure

V A B

11.

1:1 X X X X

12. Personal Protective

Equipment X X

X X

13. Negative Pressure

Re-breathing Circuit X X X X

14. Decontamination

Shower 1:1 X X X X

15. Split Air Condition Unit 1:1 X X X X

(107)

90

V A B

1. Defi brillator with TCP

Capabilities 1:4 X X X X

2. Infusion Pumps 1:2 X X X X

4. Blood Warmer 1:2 X X X X

5. Blood Cuff with

Manometer 1:2 X X X X

6. Illuminated X–ray

Viewer 1:2 X X X X

(with BiPAP/CPAP) 1:4 X X X X

8. ETCO₂ Monitor 1:5 X X X X

9. Level 1 Rapid Fluid

Infuser Machine 1:4 X X X X

10.

Diffi cult Airway Management set

– shown below

1:4 X X X X

12. Dextrostic Set

(CBS Testing) 1:4 X X X X

14. Blood Fridge 1:8 X X X X

15. Patient Transport Kit

– shown below 1:8 X X X X

(108)

91

V A B

17. Thermometer (Digital) 1:1 X X X X

18.

WARMING Blanket Air Driven or Equivalent

1:4 X X X X

19.

Microwave Oven for Rapid Warming /Warming Cabinet

1:8 X X X X

20. Tracheotomy Set 1:4 X X X X

(109)

92

V A B

1. Laryngeal Scope

– Fibre Optic 1 Set X X X X

2.

Laryngeal Scope with Flap Lip – Fibre Optic

1 Set X X X X

3. Oxygen Resuscitator

Kit 1 Set X X X X

4.

Supraglottic Airways (LMA)

/LTS Different Sizes

1 Set X X X X

5. Introducer (Stylet) 1 Set X X X X

6. Tracheotomy Set 1 Set X X X X

7. Bougie 1 Set X X X X

8. Esophageal Balloon

Detector 1 Set X X X X

9. Retrograde

Intubations Set 1 Set X X X X

10. Emergency

Cricothyrotomy Set 1 Set X X X X

11. Jet ventilation Set 1 Set X X X X

12. Percutaneous

Tracheotomy Set 1 Set X X X X

13.

Mc Coy Laryngoscopic Blade

2 Sets X X X X

14. Magill Laryngoscopic Blade (Fibre Optic) Different Sizes

(110)

93

Bil. Subject Structure

V A B

15. Coloric Capnometer

+ Capnograph 1 X X X X

16.

Laryngoscope with Video Capability (Video Larygnscope)

1 Set X X X X

17.

Bronchoscope /Flexible Intubation Scope

(111)

94

V A B

1. Transport Trolley X X X X

2. Long Spinal Board X X X X

3. Short Spinal board X X X X

4. Scoop Stretcher X X X X

5. Pole Stretcher X X X X

8.

Automated External Defi brillator with Monitor

X X X X

9. Portable Resuscitator X X X X

10. Portable Transport

Ventilator (+PEEP) X X X X

11. Portable Cardiac

Monitor X X X X

12. Portable Suction Pump X X X X

13. Two Way

Communication Set X X X X

14. Oxygen Cylinder at

Least Size D X X X X

15.

Transport Monitors with HR, RR, ECG and SpO₂ Parameters

X X X X

16. Portable Handheld

ETCO₂ Monitor X X X X

17. Airway Management

(112)

95

Bil. Subject

V A B

1. Nebulizer Machine

– Electricity Driven 1:2 X X X X

2. Peak Flow Meter

(Manual) 1:4 X X X X

3. Oxygen Regulator

with Connector 1:1 X X X X

4. SpO₂ Machine 1:4 X X X X

5. NIBP Set 1:4 X X X X

7. Wall Source Oxygen

& Tubing 1:1 X X X X

8. Nebulizer Mask Set 1:1 X X X X

9. Ergonomic Chairs

/Seats 1:1 X X X X

10. Ergonomic Doctors

Examination Table 1 X X X X

11. Suction Outlet 1:1 X X X X

12. Ventilation Fan As Required X X X X

13. Emergency

Resuscitation Cart 1 X X X X

14. X-ray Viewer 2 X X X X

(113)

96

Bil. Subject Structure

V A B

1.

OSCC Examination Chair

– Complete Set

1 X X X X

2. Diagnostic Set 1 X X X X

3. Weighing Machine 1 X X X X

4. Sphygmomanometer

/NIBP Set 1 X X X X

5. Cupboard for

Equipment 1 Set X X X X

6. One Stop Crises

Centre Kit As Required X X X X

7. Digital Camera

/Instant Camera 1 X X X X

8. Specimen handling

Area 1 X X X X

9. Wash Basin 1 X X X X

10. Toilet and Shower

Area X X X X

11. Counselling Area X X X X

12. Rest Area X X X X

13. Video Colposcopy

(114)

97

Bil. Subject Structure

V A B

1 POP Cutter with

Vacuum 1 Set X X X X

2 POP Shredder 2 X X X X

3 POP Splitter 2 X X X X

4. POP Scissor 2 X X X X

5. Mobile POP Trolley 1 X X X X

6. Entonox with

Delivery Device 1 X X X X

7. Image Intensifi er

with Fluoroscopy 1 X X X X

8. Wall O2 Source with

Bubble Humidifi er 2 X X X X

9. Wall Suction with

Regulator 2 X X X X

10. POP OT Table 1 X X X X

11. Wall O2 with Bubble

Humidifi er 2 X X X X

12. Wall Air 2 X X X X

13. Wall Vacuum with

Regulator 2 X X X X

14. X-Ray Viewer 2 X X X X

15 Ring Cutter 2 X X X X

16. Vital Sign Transport

Monitor 1 X X X X

(115)

98

Bil. Subject Structure

V A B

1. Air Way Adjunct

Manikin As Required X X X X

2. Adult CPR Manikin As Required X X X X

3. Adult Choking

4. Infant CPR Manikin As Required X X X X

5. Infant Choking

6. Algorithm Manikin

(ACLS) As Required X X X X

7. Trauma Manikin As Required X X X X

8. Adult Airway Management Manikin & Cricothyrodotomy Trainer

As Required X X X X

9.

Pediatric Airway Management Manikin

As Required X X X X

10. I/V Intervention Limb

(Upper & Lower) As Required X X X X

11.

Chest Drain Simulator /Intervention

As Required X X X X

12. Bag Valve Mask As Required X X X X

13. Pocket Mask As Required X X X X

(116)

99

Bil. Subject Structure

V A B

15. Computer with

Printer As Required X X X X

16. LCD Projector As Required X X X X

17. Screen Projector As Required X X X X

18. X-ray Illuminator As Required X X X X

19. Intra-osseous

Mannequin As Required X X X X

20. Digital Camera As Required X X X X

21. Polaroid Camera As Required X X X X

22. Video Camera As Required X X X X

23. ACLS Simulator As Required X X X X

24.

Multiple Modality Simulator (e.g. Sim Man)

As Required X X X X

25. Central Venous

Catheter Simulator As Required X X X X

(117)

100

12. Disaster Management

V A B

1. Disaster Tent 90’x90’ X X X X

2. Generator X X X X

3. Portable Fan X X X X

4. Scope Stretcher X X X X

5 Pole Stretcher X X X X

7. Medical Equipment

Chest Box X X X X

8. Trauma Equipment

Chest Box X X X X

10. Safety Helmet X X X X

11. Safety Protective Gear X X X X

12. Safety Cone X X X X

13. Cordon Tape X X X X

14. Emergency Light X X X X

15. Trauma Rescuer Kit X X X X

Equipment X X X X

17. Decontamination

Tent (Portable) X X X X

18. Torch Light X X X X

19. Radiation Meter

(118)

101

Bil. Subject Structure

V A B

20. Ice Maker X X X X

21. Cooling Fan with

Water/Mist Spray X X X X

22. Loud Hailer X X X

23. Triage Cards X X X X

24. Foldable Couch X X X X

25. Evacuation Chair X X X X

26. Simple Foldable Chair X X X X

27. Search Light X X X X

28. Helmet Torch Light X X X X

29. Fire Retardant

Jump Suit X X X X

30. Protective Jacket

Waterproof X X X X

31. Protective Shoes

with Steel Toe Tip X X X X

32.

Identifi cation Vest for Various Situations e.g. Doctor, Medical Commander, Triage Offi cer etc

X X X X

33. Foldable Table X X X X

34. Detachable IV Pole

for Pole Stretcher X X X X

35. Protective Gloves X X X X

36. Disaster Trolley

(119)

102

Bil. Subject Structure

V A B

1. Cushions & Sofa Set

(Ergonomic Design) X X X X

2. TV X X X X

3. Prayer Area X X X X

4. Bathroom/Toilet X X X X

5. Patient Information

– Reading Material X X X X

(120)

103

V A B

Equipment X X X X

2. Negative Pressure

Re-breathing Circuit X X X X

3. Build in Shower and

Toilets X X X X

4. Resuscitation Bed X X X X

5. Intercoms X X X X

(121)

104

V A B

1.

Call Centre Communication System

As Required X X X X

2. EMTS Kit As Required X X X X

3. Immobilization Set As Required X X X X

4. Airway Management Set As Required X X X X

5. Automated External

Defi brillator As Required X X X X

6. Scope Stretcher As Required X X X X

7. Extrication Device As Required X X X X

with PEEP As Required X X X X

9. Vital Sign Transport

Monitor As Required X X X X

10. Spinal Board As Required X X X X

11. Oxygen Tank with

Oxygen Regulator As Required X X X X

12. Portable Suction

Machine As Required X X X X

13. Extrication Chair As Required X X X X

14. Helmet with Helmet

Torch Light As Required X X X X

15. Fire Retardant

Jump Suit As Required X X X X

16. Protective Jacket

(122)

105

Bil. Subject Structure

V A B

17. Identifi cation Vest As Required X X X X

18. Handheld SPO₂ As Required X X X X

19.

IV set Including Adult and Pediatric Interosseous Needle

As Required X X X X

20. Pressure Bag for IV

Bottle As Required X X X X

21. Torch Light As Required X X X X

22. Foldable Wheel

Chair As Required X X X X

23. Dead Body

Management Kit As Required X X X X

24. Motorcycle

Ambulance As Required X X X X

25. Emergency Doctors

Response Car As Required X X X X

26. Patient Transport

Service Vehicle As Required X X X X

27. Land Ambulance As Required X X X X

28.

Mobile Command & Communication Vehicle

(123)

106

Bil. Subject Structure

V A B

1.

Anesthetic Machine with Attached Ventilator Gases Equipment

X X X X

2.

Monitoring Equipment – ECG, BP, PR, SpO_2, ETCO₂

X X X X

3.

X X X X

4.

Airway Management Set – BVM, HFM, Nasal Prongs, Oro- & nasopharyngeal Airways, ETTs, Laryngoscopes, Stylet

X X X X

5. Manual Defi brillator X X X X

6. Transvenous

Pacemaker X X X X

7. Image Intensifi er

Limb & Fluoroscopy X X X X

8. Bronchoscope X X X X

9. OGDS X X X X

10.

OT Table, Radiolucent Allow For Image Intensifi er

(124)

107

V A B

11. Wall O2 with Bubble

Humidifi er X X X X

12. Wall Air X X X X

13. Wall Vacuum

(125)

108

V C B

1. CCTV X X X X

2. Security Guards X X X X

3. Electronic Security

Door Locks X X X X

4. Intercom & Paging

System X X X X

5. Emergency Alert

System X X X X

Bil. Subject Structure

V C B

1. Drying Cabinet X X X X

2. Portable Autoclave X X X X

3. Sterad X X X X

4. Deep Stainless

Steel Sink X X X X

5. Big Containers

/Tub for Soaking X X X X

6. Wall Air with Air Gun X X X X

7. Drying Rack X X X X

(126)

109

V C B

1. Hyperbaric Chamber (Selected Hospitals Only) 2. Portable Hyperbaric Chambers (Selected Hospitals Only) 3. Portable Negative Pressure Tent (Selected Hospitals Only)

4. ENT Examination

Table X X X X

5. Dental Chair X X X X

(127)

(128)

(129)

(130)

113

Services Average For Busiest Shift Number Ambulance Required

Pre Hospital Care Response (Primary Response + Secondary Response)

2.4 2

Interfacility Transfer 3.8 4

Medical Standby/Day 2 2

Total - 8

+ 30% - 2

(131)

(132)

(133)

(134)

(135)

(136)

(137)

(138)

(139)

(140)

(141)

(142)

(143)

(144)

(145)

(146)